Peer Review

Summary

Rotary District project to provide a hospital with safe and adequate supply of water

Background

Knowing that Blue Planet Run normally works with implementers to expand their capacity and avoids "one-off" projects, we would like to propose this one due to its great need and will await for the group of peers to decide.

The 200 bed Kisii District Hospital, in the western Kenya highlands, was built in 1916 and has expanded through the years to accommodate 332 in-patients and a daily average of 500 out-patients. Bed occupancy ranges from 130% to 230% during the past ten years and has gone as high as 550% during times of malaria outbreaks. The hospital serves 525,000 people directly and is a referral facility for an additional 2,430,000. The Kisii area has a high density of AIDS victims and is known for the prevalence of the deadly highlands malaria after the rainy season.

The hospital's water needs are 180,000 litres per day. If all systems are functioning properly, the hospital has 40,000 litres of water per day from the following sources: 15,000 from a borehole, 10,000 litres from water harvesting and 15,000 litres from the municipal water system. The municipal system was put in place 30 years ago when the hospital had 200 beds and the population of the area was a fraction of what now exists. The equipment frequently breaks down and the hospital goes long periods of time with only enough water to use for essential services. Outdoor latrines are used, sheets are not provided for beds, polluted river water is purchased from vendors to use for cleaning and doctors and nurses have little water to clean their hands after treating patients. Much more information about the terrible conditions at the hospital is available.

Location

Kisii,
Kisii Central District,
Kenya

Focus

Primary Focus: Other
Secondary Focus: Other

People Getting Safe Drinking Water:
0

This number is people who get a constant supply for 'life' and a hospital is a transient place, so the number here is zero.

School Children Getting Water:
0

People Getting Sanitation:
0

People Getting Other Benefits:
52,500

People using the hospital annually

Application Type: Project Funding

Start Date: 2007-01-10

Completion Date: 2007-10-19

Technology Used:

There is a spring located approximately a mile from the hospital that has sufficient flow, as tested by several water engineers, to provide in excess of 300,000 litres of water per day to the hospital and to the nearby community. The spring is on public property and approval to use it for the hospital and community has been obtained. The cost of protecting the spring, pumping it to the hospital, establishing access to the community and providing security is $65,500. The hospital has maintenance personnel trained to operate and maintain the equipment and infrastructure required for the project. Maintenance funds will be generated by savings from no longer buying water from the municipal supply. This will also benefit the community by having more water available for businesses and household use. Specific details on the project plan have been developed and are available for review.

Phases:

The project will be done in one phase taking approximately six months to complete once funds are in place.

Community Organization:

The Kisii Hospital Board is composed of members of the community and hospital staff. They are obtaining funds from the government's newly established regional self-help program to improve plumbing and sanitation. They have obtained legal rights to use the spring and organized the local community to help dig the pipeline from the spring to the hospital and to a local water point where the community will be able to obtain water for washing clothes and drinking..

Government Interaction:

Ancillary activities:

Other Issues:

Blue Planet Run will be prominently displayed as a partner with Rotary on a large plaque at the entrance of the hospital. There will be widespread publicity throughout the area and in Kenya's national news about the project and the role Blue Planet Run has played. It would also be good if some runners from Kenya are participating in the Run so they could be mentioned and thereby increase awareness of the upcoming event.

The lead is Don Howard. He and his wife will be going to Kenya in April and August to visit the projects and document results through video interviews, pictures and reports. Local Rotary Clubs will be responsible for disbursing funds, monitoring results, maintaining records and solving problems. Hospital maintenance personnel will be trained to operate and maintain the equipment.

Maintenance Revenue:

Maintenance funds will be derived from the savings generated by not using the municipal water system and water vendors. The District Water Engineer, who ill supervise the project, will assit on training and do scheduled maintenance inspections.

Maintenance Cost:

Metrics:

Prior art before metrics

Cost: $65,650

Protection of the spring, 25 cubic meter intake pump, construction of pump house, electrical pump set, pipeline from spring to hospital and from spring to community water point, upgrade of electricity, purification system. $44,000

Plumbing and storage tank. $17,100.

Administration and supervision. $4,550

Co Funding Amount: $45,650

Hurlingham-Nairobi Rotary Club, several rotary Clubs in the Denver, Colorado area, Rotary District 5450 and Rotary International Foundation.

Community Contribution
Amount:

The Kisii Hospitla Board is comprised of members of the local community. They have obtained legal permission from the government to use the spring. They also have organized the community to help laying pipeline from the spring to the hospital and water point.

Fund Requested: $22,000

Implementing Organization:

Project after completion management

Idriss Kamara of Safer Future Youth Development Project

I only read that the Hospital will have responsibility. How about he community'?

I only read that the Hospital will have responsibility. How about he community'?

Don Howard of Rotary District 5450

Community involvement is in two areas. First, the Hospital Board of Directors is composed of members of the Community. They play an active role in monitoring the hospitals activities and developing plans. The water problem is their main area of concern. Patients now must have a family member or paid caretaker to bring water, wash clothes...

Community involvement is in two areas. First, the Hospital Board of Directors is composed of members of the Community. They play an active role in monitoring the hospitals activities and developing plans. The water problem is their main area of concern. Patients now must have a family member or paid caretaker to bring water, wash clothes and linens and assist in using outdoor latrines during the requent times when water is not available.

The second area of community involvement is to provide labor, skilled and unskilled, to work on the project.

Spring ownership

Idriss Kamara of Safer Future Youth Development Project

Who directly owns the spring after your work ? Can it not be taken from them one day. Please do proper ownership agreement with who soever is involved.

Who directly owns the spring after your work ? Can it not be taken from them one day. Please do proper ownership agreement with who soever is involved.

Don Howard of Rotary District 5450

I had the same concern when I met with the Dr. Mbugwe, Kisii Hospital Superintendent. The spring is located on public land and a written agreement was being obtained from the government by the Hospital Board. I'll check with Dr. Mbugwe to confirm that the agreement has been finalized.

I had the same concern when I met with the Dr. Mbugwe, Kisii Hospital Superintendent. The spring is located on public land and a written agreement was being obtained from the government by the Hospital Board. I'll check with Dr. Mbugwe to confirm that the agreement has been finalized.

Savings from not paying municipal water rates

Idriss Kamara of Safer Future Youth Development Project

Is the saving from not paying the municipal water rates going to be collected,how and by whom ?

Is the saving from not paying the municipal water rates going to be collected,how and by whom ?

Don Howard of Rotary District 5450

The savings realized from not paying for the municipal water (they will still be paying for sanitation services provided through the sewage system) will be realized through cost avoidance. The hospital Superintendent explained that the funds saved from not buying the water from the city and street vendors will be used for system maintenanc...

The savings realized from not paying for the municipal water (they will still be paying for sanitation services provided through the sewage system) will be realized through cost avoidance. The hospital Superintendent explained that the funds saved from not buying the water from the city and street vendors will be used for system maintenance.

Hygiene Education

Susan Davis of CARE

Clearly quantity of water is a requirement for adequate hygiene. But safe storage and diligent hygiene practices are also necessary. Are there plans to include training on this for all hospital staff?

Clearly quantity of water is a requirement for adequate hygiene. But safe storage and diligent hygiene practices are also necessary. Are there plans to include training on this for all hospital staff?

Don Howard of Rotary District 5450

I asked Dr. Mogoa, hospital superintendent, about hygiene training. Kisii is a teaching hospital with an adjacent training facility for nurses. An education program for nurses, doctors and staff is already imn place. He talked about expanding the hygiene information offerred patients. In the previous comment, John Anner, East Meets West, s...

I asked Dr. Mogoa, hospital superintendent, about hygiene training. Kisii is a teaching hospital with an adjacent training facility for nurses. An education program for nurses, doctors and staff is already imn place. He talked about expanding the hygiene information offerred patients. In the previous comment, John Anner, East Meets West, suggested some materials promoting hand washing which I will share with Dr. Mogoa. When I visit Kisii Hospital next May and August, I'll follow up on questions about hygiene and sanitation.

A few questions

Ned Breslin of Water for People

Thanks for this proposal.
Hospital/clinic water projects consistently fail because key issues of management and finance are not addressed. I understand the idea that savings from municipal supplies will be allocated to this new scheme, but has a real analysis of costs and savings been done? Is the amount currently being paid to the mu...

Thanks for this proposal.

Hospital/clinic water projects consistently fail because key issues of management and finance are not addressed. I understand the idea that savings from municipal supplies will be allocated to this new scheme, but has a real analysis of costs and savings been done? Is the amount currently being paid to the municipality available to cover the costs of the new scheme? If there is a gap how will that be addressed?

One reason hospitals are hard is for exactly the same reasons supplied in the proposal - there are no sheets, doctors overstretched, the hospital is broken despite the heroic efforts of staff to provide a service. The challenge with all health sector issues like this is how do you solve the dysfuctional system as a whole? What many donors do is they come in with a solution to one part of the problem (like water) but that solution collapses under the weight of the other problems. I say this from experience and have seen it many times. I would be interested in Rotary's view on this issue.

This project is basically using Rotary as the implementor. Does Rotary really have this capacity as described in the proposal? My experience with Rotary is that their work is best when they are working with sector professionals. Polio Plus was linked with WHO, local NGOs in the sector and the health sector, so it was comprehensive and well thought out - I am not clear where all the key role players are in this project. The hospital staff are not water people. The district engineer clearly struggles. This project may have a better chance of success if it was linked more effectively with other sector leaders. That is just a thought - I would be interetsed in Rotary's insight into this.

Clearly a desperate need and thanks for trying to solve this problem, and I hope my questions are seen as trying to push you all to get key issues resolved so that the project has a real chance of success.

Thanks
ned

Don Howard of Rotary District 5450

Thanks for the background Ned. I don't pretend to be an expert in the technical aspects of water projects and I have had little experience in dealing with water problems at hospitals. I'm learning and appreciate any help offerred.
You asked for Rotary's view on dealing with dysfunctional systems. I can't answer for Rotary International...

Thanks for the background Ned. I don't pretend to be an expert in the technical aspects of water projects and I have had little experience in dealing with water problems at hospitals. I'm learning and appreciate any help offerred.

You asked for Rotary's view on dealing with dysfunctional systems. I can't answer for Rotary International, but I know that the very questions you raise are being studied. Rotary has more than 30,000 clubs all over the world pledged to serve their community. We've been doing projects for over 100 years with the polio eradication effort serving as the example of what can be accomplished when we join forces with other organizations. Rotary's dedication to providing clean water is in the infancy stage. How do we put all our clubs to work? Where do we fit in the sequence of transforming money into projects? How can we speed up the the process from project recognition to implementation? Strategic planning has begun, but we are all a long way from from working with others to mold a cohesive action plan.

I've visited the hospital twice and have had meetings with Dr. Mogoa, Hospital Superintendent, his staff, the District Water Engineer, a consulting firm, and the electrical and construction personnel that are prepared to implement the project. I also inspected the spring that will be the source of clean water and talked with the District Water Engneer about the test results. The water is good and the flow will be able to fill the storage capacity of the hospital with a considerable amount of additional capacity untapped. I'm convinced that the water problems can be eliminated by this project.

I'm also convinced that maintenance funds will be available. The primary source of funds will be the money saved by not buying water from vendors and the municipal source. Dr. Mogoa went over these figures with me and the amounts involved are substantial. There are also funds for hospital improvement provided by the patients. They are charged the 100 KSH ($1.40) a day for their stay. This money becomes part of a fund used for hospital improvements and maintenance. The combination of these two sources should provide adequate resources to insure project sustainability.
ways the money is currently being used is to replace leaking pipes and to renovate all showers and latrines.

The Rotary Club sponsoring the project is located in Nairobi, a distance of 150 kilometers. They are planning to use an NGO that we have worked with in the past or a water consulting firm to assist in monitoring the project. The Rotary Club will accept and disburse funds, maintain records, provide reports and monitor the work periodically. These are the normal functions clubs do, though there often is more direct involvement in some projects.

I have a lot more that I could offer, but it's time to stop for now. Thanks for the thoughtful assessment. I would be most interested in hearing of your experiences in dealing with hospitals and other projects. Where is that book on lessons learned and best practices.

Don

Don

Rick McGowan of East Meets West Foundation

Proposed Expansion of Kisii Hospital Water Supply
Situation Summary - The 200 bed Kisii District Hospital, in the western Kenya highlands, was built in 1916 and has expanded through the years to accommodate 332 in-patients and a daily average of 500 out-patients. Bed occupancy ranges from 130% to 230% during the past ten years and has gon...

Proposed Expansion of Kisii Hospital Water Supply

Situation Summary - The 200 bed Kisii District Hospital, in the western Kenya highlands, was built in 1916 and has expanded through the years to accommodate 332 in-patients and a daily average of 500 out-patients. Bed occupancy ranges from 130% to 230% during the past ten years and has gone as high as 550% during times of malaria outbreaks.

Current Demand Ã¢â‚¬â€œ 180,000 LPD (i.e., 180 cubic meters per day - CMD), and existing sources (totaling 40 cm/day, or only 22% of current demand) are Ã¢â‚¬â€œ 15 CMD from a borehole, 10 CMD from water harvesting (does this mean rainwater catchment or gray-water recycling?) , and 15 CMD from the municipal water system. Constant breakdowns of water supply further complicate the situation.

Water Demand Calculation - According to WHO standards for domestic use in emergency situations (which may or may not apply in this situation), water demand for Health Centers is: 5 liters per out-patient; and 40-60 liters per In-patient. For hospitals (with laundry facilities) the demand is 220-300 liters per bed. So for this situation, with 332 beds (presumably same as the number of in-patients) the total demand is somewhere between 73 Ã¢â‚¬â€œ 100 CMD. Go for the high side to be safe. Then if you assume that the 500 out-patients consume half that amount per capita, add another 55-75 CMD for a high-side total of 175 CMD (or 175,000 liters) per day. Therefore, their demand estimate is right on for the current situation, but does not appear to include further demand growth over time. However, the proposed incremental source with a measured capacity of 300 CMD is more than adequate for future expansion. Question Ã¢â‚¬â€œ is the proposed source not currently being used? Who owns the source? Who can guarantee that it might not be developed by some other agency or company in the near future? Confirm the long term availability of and legal access to the source, if this has not already been done.

Recommendation for the proposed water system addition Ã¢â‚¬â€œ Two Thumbs Up (as they say in the movie reviews). Do it, and if the situation is such that the hospital itself may expand its patient capacity over the short-medium term, then the system planners should take that fully into account in designing the currently proposed expansion.

Other Issues to Consider

A water demand management (i.e., conservation) program, including automatic shutoff valves, low flow toilets and showers, grey water recycling, etc. to minimize the need for expensive additional capacity.
Rainwater catchment as a potentially important supplemental source of water during and shortly after the rainy season.
Promoting hand washing with soap among both staff and patients.
Financial sustainability Ã¢â‚¬â€œ So far it seems that only capital investment costs are being considered. It is important to also plan for O&M, repair, replacement and possibly further expansion costs. Who will pay for these costs? You can't expect the government to do much here, and the patients are unlikely to be able to afford even basic medical service costs. The proposal should specify how these costs will be covered. Otherwise the system will fail financially.

Having visited several hospitals that are probably like this one, I guess that I don't really want to know much detail about the Ã¢â‚¬Å“outdoor latrinesÃ¢â‚¬Â, but I would imagine that they are a significant disease vector. A basic hand-washing (with soap) campaign would likely provide significant health benefits at a relatively low cost. The World Bank Regional Water and Sanitation Program (RWSP) in East Africa (http://www.wsp.org/07_Africa.asp) and numerous other donor and NGO organizations have ready-to-use IEC materials on promoting handwashing in Kiswahili and English (and possibly even some of the local languages). The proposed program should make a concerted effort to at least disseminate these materials for the health car providers.

Don Howard of Rotary District 5450

Thank you John for your comments and suggestions. The water source is from a spring approxomately one kilometer from the hospital. Although near the hospital, the spring is in a ravine an somewhat inaccessible. It is on government land and permission to develop the source and improve accessibility for the community as well as the hospital...

Thank you John for your comments and suggestions. The water source is from a spring approxomately one kilometer from the hospital. Although near the hospital, the spring is in a ravine an somewhat inaccessible. It is on government land and permission to develop the source and improve accessibility for the community as well as the hospital has been granted by the government. The area will be protected and water will be piped to the hospital and to an access point the community will use for drinking and washing clothes.

As far as capacity is concerned, the hospital is already using rainwater harvesting extensively, has a low yeild well and relies on the municipal water system when it works. Only one third of the water needed by the hospital are met by these sources and the municipal system is unable to meet the needs of the community and the hospital due to the population growth since the system was installed. The Kenya Government has pledged to expand th municipal supply but there is no timetable for the work to be done. The measured spring is sufficient to meet the existing needs of the hospital and community with a 30% excess to draw upon in the future.

Maintenance costs for now and in the future will have two primary sources of funding. The hospital charges a daily fee of approximately $1.40 which is used for maintenance and hospital improvement. This money is now being used to redo all the hospital plumbing, tile the showers and repair leaks in the piping. Funds will also be avialable because the hospital will no longer have to pay water vendors or the municipal water system. The amount saved will easily cover maintenace costs.

Thanks for the information about hand washing literature. The hospital Superintendent already has an education program for patients and staff, but the availability of these materials may be helpful.

To be honest, my comments are based on three trips to the hospital and discyussions with the Superintendent. I was impressed with his dedication and committment to improve the hospital. he has been there for eight years and has made significant improvements. I trust him. I alos trust the checks and balances in the Rotary system for matching grants. Accountability is an important part of the program. I'll be visiting Kisii twice in the next year. I hope that my trust is well placed.

Don Howard of Rotary District 5450

Thank you John for your comments and suggestions. The water source is from a spring approxomately one kilometer from the hospital. Although near the hospital, the spring is in a ravine an somewhat inaccessible. It is on government land and permission to develop the source and improve accessibility for the community as well as the hospital...

Thank you John for your comments and suggestions. The water source is from a spring approxomately one kilometer from the hospital. Although near the hospital, the spring is in a ravine an somewhat inaccessible. It is on government land and permission to develop the source and improve accessibility for the community as well as the hospital has been granted by the government. The area will be protected and water will be piped to the hospital and to an access point the community will use for drinking and washing clothes.

As far as capacity is concerned, the hospital is already using rainwater harvesting extensively, has a low yeild well and relies on the municipal water system when it works. Only one third of the water needed by the hospital are met by these sources and the municipal system is unable to meet the needs of the community and the hospital due to the population growth since the system was installed. The Kenya Government has pledged to expand th municipal supply but there is no timetable for the work to be done. The measured spring is sufficient to meet the existing needs of the hospital and community with a 30% excess to draw upon in the future.

Maintenance costs for now and in the future will have two primary sources of funding. The hospital charges a daily fee of approximately $1.40 which is used for maintenance and hospital improvement. This money is now being used to redo all the hospital plumbing, tile the showers and repair leaks in the piping. Funds will also be avialable because the hospital will no longer have to pay water vendors or the municipal water system. The amount saved will easily cover maintenace costs.

Thanks for the information about hand washing literature. The hospital Superintendent already has an education program for patients and staff, but the availability of these materials may be helpful.

To be honest, my comments are based on three trips to the hospital and discyussions with the Superintendent. I was impressed with his dedication and committment to improve the hospital. he has been there for eight years and has made significant improvements. I trust him. I alos trust the checks and balances in the Rotary system for matching grants. Accountability is an important part of the program. I'll be visiting Kisii twice in the next year. I hope that my trust is well placed.

Rick McGowan of East Meets West Foundation

Proposed Expansion of Kisii Hospital Water Supply
Situation Summary - The 200 bed Kisii District Hospital, in the western Kenya highlands, was built in 1916 and has expanded through the years to accommodate 332 in-patients and a daily average of 500 out-patients. Bed occupancy ranges from 130% to 230% during the past ten years and has gon...

Proposed Expansion of Kisii Hospital Water Supply

Situation Summary - The 200 bed Kisii District Hospital, in the western Kenya highlands, was built in 1916 and has expanded through the years to accommodate 332 in-patients and a daily average of 500 out-patients. Bed occupancy ranges from 130% to 230% during the past ten years and has gone as high as 550% during times of malaria outbreaks.

Current Demand Ã¢â‚¬â€œ 180,000 LPD (i.e., 180 cubic meters per day - CMD), and existing sources (totaling 40 cm/day, or only 22% of current demand) are Ã¢â‚¬â€œ 15 CMD from a borehole, 10 CMD from water harvesting (does this mean rainwater catchment or gray-water recycling?) , and 15 CMD from the municipal water system. Constant breakdowns of water supply further complicate the situation.

Water Demand Calculation - According to WHO standards for domestic use in emergency situations (which may or may not apply in this situation), water demand for Health Centers is: 5 liters per out-patient; and 40-60 liters per In-patient. For hospitals (with laundry facilities) the demand is 220-300 liters per bed. So for this situation, with 332 beds (presumably same as the number of in-patients) the total demand is somewhere between 73 Ã¢â‚¬â€œ 100 CMD. Go for the high side to be safe. Then if you assume that the 500 out-patients consume half that amount per capita, add another 55-75 CMD for a high-side total of 175 CMD (or 175,000 liters) per day. Therefore, their demand estimate is right on for the current situation, but does not appear to include further demand growth over time. However, the proposed incremental source with a measured capacity of 300 CMD is more than adequate for future expansion. Question Ã¢â‚¬â€œ is the proposed source not currently being used? Who owns the source? Who can guarantee that it might not be developed by some other agency or company in the near future? Confirm the long term availability of and legal access to the source, if this has not already been done.

Recommendation for the proposed water system addition Ã¢â‚¬â€œ Two Thumbs Up (as they say in the movie reviews). Do it, and if the situation is such that the hospital itself may expand its patient capacity over the short-medium term, then the system planners should take that fully into account in designing the currently proposed expansion.

Other Issues to Consider

A water demand management (i.e., conservation) program, including automatic shutoff valves, low flow toilets and showers, grey water recycling, etc. to minimize the need for expensive additional capacity.
Rainwater catchment as a potentially important supplemental source of water during and shortly after the rainy season.
Promoting hand washing with soap among both staff and patients.
Financial sustainability Ã¢â‚¬â€œ So far it seems that only capital investment costs are being considered. It is important to also plan for O&M, repair, replacement and possibly further expansion costs. Who will pay for these costs? You can't expect the government to do much here, and the patients are unlikely to be able to afford even basic medical service costs. The proposal should specify how these costs will be covered. Otherwise the system will fail financially.

Having visited several hospitals that are probably like this one, I guess that I don't really want to know much detail about the Ã¢â‚¬Å“outdoor latrinesÃ¢â‚¬Â, but I would imagine that they are a significant disease vector. A basic hand-washing (with soap) campaign would likely provide significant health benefits at a relatively low cost. The World Bank Regional Water and Sanitation Program (RWSP) in East Africa (http://www.wsp.org/07_Africa.asp) and numerous other donor and NGO organizations have ready-to-use IEC materials on promoting handwashing in Kiswahili and English (and possibly even some of the local languages). The proposed program should make a concerted effort to at least disseminate these materials for the health car providers.

Don Howard of Rotary District 5450

Thank you John for your comments and suggestions. The water source is from a spring approxomately one kilometer from the hospital. Although near the hospital, the spring is in a ravine an somewhat inaccessible. It is on government land and permission to develop the source and improve accessibility for the community as well as the hospital...

Thank you John for your comments and suggestions. The water source is from a spring approxomately one kilometer from the hospital. Although near the hospital, the spring is in a ravine an somewhat inaccessible. It is on government land and permission to develop the source and improve accessibility for the community as well as the hospital has been granted by the government. The area will be protected and water will be piped to the hospital and to an access point the community will use for drinking and washing clothes.

As far as capacity is concerned, the hospital is already using rainwater harvesting extensively, has a low yeild well and relies on the municipal water system when it works. Only one third of the water needed by the hospital are met by these sources and the municipal system is unable to meet the needs of the community and the hospital due to the population growth since the system was installed. The Kenya Government has pledged to expand th municipal supply but there is no timetable for the work to be done. The measured spring is sufficient to meet the existing needs of the hospital and community with a 30% excess to draw upon in the future.

Maintenance costs for now and in the future will have two primary sources of funding. The hospital charges a daily fee of approximately $1.40 which is used for maintenance and hospital improvement. This money is now being used to redo all the hospital plumbing, tile the showers and repair leaks in the piping. Funds will also be avialable because the hospital will no longer have to pay water vendors or the municipal water system. The amount saved will easily cover maintenace costs.

Thanks for the information about hand washing literature. The hospital Superintendent already has an education program for patients and staff, but the availability of these materials may be helpful.

To be honest, my comments are based on three trips to the hospital and discyussions with the Superintendent. I was impressed with his dedication and committment to improve the hospital. he has been there for eight years and has made significant improvements. I trust him. I alos trust the checks and balances in the Rotary system for matching grants. Accountability is an important part of the program. I'll be visiting Kisii twice in the next year. I hope that my trust is well placed.

Don Howard of Rotary District 5450

Thank you John for your comments and suggestions. The water source is from a spring approxomately one kilometer from the hospital. Although near the hospital, the spring is in a ravine an somewhat inaccessible. It is on government land and permission to develop the source and improve accessibility for the community as well as the hospital...

Thank you John for your comments and suggestions. The water source is from a spring approxomately one kilometer from the hospital. Although near the hospital, the spring is in a ravine an somewhat inaccessible. It is on government land and permission to develop the source and improve accessibility for the community as well as the hospital has been granted by the government. The area will be protected and water will be piped to the hospital and to an access point the community will use for drinking and washing clothes.

As far as capacity is concerned, the hospital is already using rainwater harvesting extensively, has a low yeild well and relies on the municipal water system when it works. Only one third of the water needed by the hospital are met by these sources and the municipal system is unable to meet the needs of the community and the hospital due to the population growth since the system was installed. The Kenya Government has pledged to expand th municipal supply but there is no timetable for the work to be done. The measured spring is sufficient to meet the existing needs of the hospital and community with a 30% excess to draw upon in the future.

Maintenance costs for now and in the future will have two primary sources of funding. The hospital charges a daily fee of approximately $1.40 which is used for maintenance and hospital improvement. This money is now being used to redo all the hospital plumbing, tile the showers and repair leaks in the piping. Funds will also be avialable because the hospital will no longer have to pay water vendors or the municipal water system. The amount saved will easily cover maintenace costs.

Thanks for the information about hand washing literature. The hospital Superintendent already has an education program for patients and staff, but the availability of these materials may be helpful.

To be honest, my comments are based on three trips to the hospital and discyussions with the Superintendent. I was impressed with his dedication and committment to improve the hospital. he has been there for eight years and has made significant improvements. I trust him. I alos trust the checks and balances in the Rotary system for matching grants. Accountability is an important part of the program. I'll be visiting Kisii twice in the next year. I hope that my trust is well placed.

Rating: 7

review by (only shown to members)

This humanitarian project would be a good example of a Rotary BPR partnership. However, from PWX viewpoint, its not clear how it fits in peer review and knowledge sharing.

Rating: 7

review by (only shown to members)

Rating: 7

review by (only shown to members)

I think the project is probably needed but key sustainability issues are missing and this may fail. As this is a Denver Rotary I could offer some advice and connect them with some NGOs that could help (WFP does not work in Kenya so this is not self-serving). I think it probably should be funded but maybe some suggestions to make it more likely to succeed would help.

I do think the issue of the dysfunctionality of the hospital is key and should not be underestimated.

Rating: 7

review by (only shown to members)

See my entry on the previous page. Do it.

But make sure that no one else is using or intending to use the water source that is to be developed by this project.